It happens to every young adult: At some point, they become too old for their pediatrician.
When it happens depends both on the young adult and the pediatric practice. Some teens are ready for a change when they become legal adults at 18, tired of sitting with babies in the waiting room. Others want to stay with their pediatrician and do until the very last minute the pediatrician will let them. As for practices, some have firm rules about when patients need to move on, while others don't, letting them stay until the early years of their 20s.
Ideally, young adults will have a smooth transition from one health care provider to another: a full and clear hand-off of all the medical and other information needed. Unfortunately, it's often not so smooth. Many young adults find themselves adrift without a doctor, which can be a problem for those with chronic health problems. And many others find themselves sitting in an office with a doctor who knows nothing about them. This situation is often made worse when that young adult doesn't know enough about their own medical history to get the doctor up to speed.
Below are some actions parents and teens or young adults can take to make sure this transition goes as smoothly as possible.
Help teens build skills and understand their health needs
• By the time your teen reaches high school age, and maybe before, give them time alone with their health care provider. This allows teens to practice self-advocacy and build necessary skills for talking about their health and health care needs.
• If your teen has a chronic health problem, teach them about it. By the time they are 18, or preferably before, they should have a solid understanding of their condition and its implications.
• If your teen takes regular medications, make sure they know the names, doses and what they are taking them for. Help them learn independence in taking their medications and also in calling for refills. Start this by high school.
• Make sure your child knows all of their allergies. Many teens do not.
Work with your pediatrician and health plan
• Plan to start the transition to another doctor at least a year ahead of time — more in some circumstances, such as when a teen has a disability or sees specialists.
• A teen with a disability may need your involvement in their life and health care past the age of 18. Talk to your doctor about whether or not guardianship would be a good idea. Aim to start this conversation by age 16, because the process can take some time.
• Ask your pediatrician when patients need to leave the practice, so you know when you need to get started on the transition. It may take a while to find a doctor and get an appointment. So, start at least a year ahead of time.
• Check with your insurance company about options for primary care practices. Look up practices and practitioners online together. Find out what you can and get recommendations from people you trust — including your pediatrician!
• If your teen sees specialists, get recommendations from them as to which specialists your teen might see as an adult. This is an important conversation to have as you look for primary care practices. It’s best if the new primary care practice is affiliated with the recommended specialist and their hospital.
What will the new doctor need to know?
• You will need to get health records transferred from your pediatrician to the new practice. If your child is 18 or older, they will have to make this request, not you. Ideally, request all of the records, perhaps on a disc or thumb drive. What the new doctor needs most are the last few notes in the record — including the last physical, and the latest specialty notes — the vaccination record, and an updated medication and allergy list.
• Make sure your teen knows their family medical history. Write down any medical problems in the family, particularly those of your teen’s parents, siblings, grandparents and other close relatives. It’s not something families often talk about, and it’s crucial information for your teen’s new doctor.
• See if your pediatrician is willing to reach out to the new primary care provider to do a “warm handoff.” Most are willing and it could make all the difference, especially if there are any special health care needs.
This may seem like a lot, but it's really not. The key is to start early, and work at it throughout your child's high school years. If you do, by the time they make the transition from a pediatrician to a new primary care doctor, everyone will be ready — not just your child, but also the new doctor, which puts your child in the best position possible as they take on life — and health care — on their own.
Claire McCarthy, M.D., is senior faculty editor at Harvard Health Publishing.